Psychosocial and Environmental Stressor Checklist

Psychosocial and Environmental Stressor Checklist
THE PSYCHOSOCIAL AND ENVIRONMENTAL STRESSORS

CHECKLIST FOR THE IDENTIFIED INFANT/YOUNG CHILD
This checklist provides the clinician with a framework for (1) identifying the multiple sources of stress experienced by an individual
infant/young child and family and (2) noting their duration and severity.
To capture the cumulative severity of stressors, the clinician should identify all the sources of stress in an infant’s/young child’s circum-
stances. For example, an infant/young child who enters foster placement may be experiencing the impact of abuse, parental psychiatric
illness, separation, and poverty. The greater the number of stressors involved, the greater the adverse impact on the infant/young child
is presumed to be.

(Complete information for all stressors that apply)
Stressors Age of onset Comments, including
(in months) duration and severity
Challenges within the infant’s/young child’s family or primary support group
Acculturation or language conflicts
Birth of a sibling
Change in primary caregiver
Criminal activity within the household
Death of a parent or important caregiver
Death of another important person
Death of other family member
Domestic violence
Emotional abuse
Family social isolation
Copyright © 2016 ZERO TO THREE. All rights reserved. 1


Father or mother absence
Inadequate social support for the family
Incarceration of family member
Infant/young child has been adopted
Infant/young child neglect
Infant/young child physical abuse
Infant/young child placed in foster care
Infant/young child placed in institutional

care
Infant/young child reunification with parent

after prolonged separation
Infant/young child sexual abuse
Medical illness of parent or caregiver

(specify acute or chronic)
Medical illness of sibling or other household

member (specify acute or chronic)
Mental health problems of household

member
New adult in household (e.g., romantic

partner)


New infant/young child (not by birth) in
home (e.g., adoption, stepsibling, foster child)
Other trauma to significant person in the

infant/young child’s life
Parent or caregiver discord or conflict

(nonphysical)
Parent or caregiver divorce or separation
Parent or caregiver mental health problems
Parent or caregiver remarriage
Parent or caregiver separation from the

infant/young child (e.g., out-of-town
employment, hospitalization)
Parent or caregiver substance abuse
Removal of nonindex infant/young child

from home
Severe discord or violence with sibling
Substance abuse by household member
Teenage parent
Unpredictable home environment
Unstable family constellation


Challenges in the social environment
Discrimination or racism is experienced by
family
Immigrant status
Inadequate access to health care
Infant/young child experiences bullying
Infant/young child is witness to community

violence
Refugee status
Unsafe neighborhood
Educational or child care challenges

Multiple changes in child care provider
Parent or caregiver low literacy
Poor quality early learning environment or

out-of-home care (e.g., health and safety
concerns, high infant/young child–staff ratios
and large groups, inadequately trained staff,
lack of attention to social and emotional
development)
Housing challenges
Eviction from home or foreclosure
Homelessness
Inadequate, unsafe, or overcrowded housing


Multiple moves
Economic and employment challenges

Dangerous or stressful parental work
conditions
Food insecurity
Heavy indebtedness
Military deployment or reintegration
Parental unemployment or job instability
Poverty or near poverty
Infant/young child health

Infant/young child accident or injury
(e.g., animal bite, passenger in vehicular
accident)
Infant/young child hospitalization
Infant/young child medical illness

(acute or chronic)
Painful or frightening medical procedure(s)
Pregnancy-related stressors
Legal or criminal justice challenges

Child protective services involvement


Custody dispute
Infant/young child is victim of crime
Parent is victim of crime
Parental arrest
Parental deportation
Parental incarceration or return from

incarceration
Undocumented immigration status
Other
Abduction (specify by family member or
nonfamily member)
Disaster (e.g., fire, hurricane, earthquake)
Disease epidemic
Other (specify)
Terrorism
War
Note: “Parent” refers to parenting figure(s).

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Psychosocial and Environmental Stressor Checklist

THE PSYCHOSOCIAL AND ENVIRONMENTAL STRESSORS

Psychosocial and Environmental Stressor Checklist

Change in primary caregiver

Criminal activity within the household

Death of a parent or important caregiver

Death of another important person

Death of other family member

Family social isolation

Copyright © 2016 ZERO TO THREE. All rights reserved. 1

Stressors Age of onset Comments, including

Inadequate social support for the family

Incarceration of family member

Infant/young child has been adopted

Infant/young child neglect

Infant/young child physical abuse

Infant/young child placed in foster care

Infant/young child placed in institutional

Infant/young child reunification with parent

Infant/young child sexual abuse

Medical illness of parent or caregiver

Medical illness of sibling or other household

Mental health problems of household

New adult in household (e.g., romantic

Copyright © 2016 ZERO TO THREE. All rights reserved. 2

Stressors Age of onset Comments, including

Other trauma to significant person in the

Parent or caregiver discord or conflict

Parent or caregiver divorce or separation

Parent or caregiver mental health problems

Parent or caregiver remarriage

Parent or caregiver separation from the

Parent or caregiver substance abuse

Removal of nonindex infant/young child

Severe discord or violence with sibling

Substance abuse by household member

Unpredictable home environment

Unstable family constellation

Copyright © 2016 ZERO TO THREE. All rights reserved. 3

Stressors Age of onset Comments, including

Inadequate access to health care

Infant/young child experiences bullying

Infant/young child is witness to community

Educational or child care challenges

Parent or caregiver low literacy

Poor quality early learning environment or

Inadequate, unsafe, or overcrowded housing

Copyright © 2016 ZERO TO THREE. All rights reserved. 4

Stressors Age of onset Comments, including

Economic and employment challenges

Military deployment or reintegration

Parental unemployment or job instability

Poverty or near poverty

Infant/young child health

Infant/young child hospitalization

Infant/young child medical illness

Painful or frightening medical procedure(s)

Legal or criminal justice challenges

Copyright © 2016 ZERO TO THREE. All rights reserved. 5

Stressors Age of onset Comments, including